Impact of COVID-19 on mental health care for Veterans: improvise, adapt, and overcome

Stress-related psychiatric disorders across the life spa

Neuroanatomical features in soldiers with post-traumatic stress disorder

BACKGROUND: Posttraumatic stress disorder (PTSD), an anxiety disorder that can develop after exposure to psychological trauma, impacts up to 20 % of soldiers returning from combat-related deployment. Advanced neuroimaging holds diagnostic and prognostic potential for furthering our understanding of its etiology. Previous imaging studies on combat-related PTSD have focused on selected structures, such as the hippocampi and cortex, but none conducted a comprehensive examination of both the cerebrum and cerebellum. The present study provides a complete analysis of cortical, subcortical, and cerebellar anatomy in a single cohort. Forty-seven magnetic resonance images (MRIs) were collected from 24 soldiers with PTSD and 23 Control soldiers. Each image was segmented into 78 cortical brain regions and 81,924 vertices using the corticometric iterative vertex based estimation of thickness algorithm, allowing for both a region-based and a vertex-based cortical analysis, respectively. Subcortical volumetric analyses of the hippocampi, cerebellum, thalamus, globus pallidus, caudate, putamen, and many sub-regions were conducted following their segmentation using Multiple Automatically Generated Templates Brain algorithm. RESULTS: Participants with PTSD were found to have reduced cortical thickness, primarily in the frontal and temporal lobes, with no preference for laterality. The region-based analyses further revealed localized thinning as well as thickening in several sub-regions. These results were accompanied by decreased volumes of the caudate and right hippocampus, as computed relative to total cerebral volume. Enlargement in several cerebellar lobules (relative to total cerebellar volume) was also observed in the PTSD group. CONCLUSIONS: These data highlight the distributed structural differences between soldiers with and without PTSD, and emphasize the diagnostic potential of high-resolution MRI

Dynamic Causal Modeling in PTSD and Its Dissociative Subtype: Bottom-Up Versus Top-Down Processing Within Fear and Emotion Regulation Circuitry

Posttraumatic stress disorder (PTSD) is associated with decreased top–down emotion modulation from medial prefrontal cortex (mPFC) regions, a pathophysiology accompanied by hyperarousal and hyperactivation of the amygdala. By contrast, PTSD patients with the dissociative subtype (PTSD + DS) often exhibit increased mPFC top–down modulation and decreased amygdala activation associated with emotional detachment and hypoarousal. Crucially, PTSD and PTSD + DS display distinct functional connectivity within the PFC, amygdala complexes, and the periaqueductal gray (PAG), a region related to defensive responses/emotional coping. However, differences in directed connectivity between these regions have not been established in PTSD, PTSD + DS, or controls. Methods: To examine directed (effective) connectivity among these nodes, as well as group differences, we conducted resting-state stochastic dynamic causal modeling (sDCM) pairwise analyses of coupling between the ventromedial (vm)PFC, the bilateral basolateral and centromedial (CMA) amygdala complexes, and the PAG, in 155 participants (PTSD [n = 62]; PTSD + DS [n = 41]; age-matched healthy trauma-unexposed controls [n = 52]). Results: PTSD was characterized by a pattern of predominant bottom–up connectivity from the amygdala to the vmPFC and from the PAG to the vmPFC and amygdala. Conversely, PTSD + DS exhibited predominant top–down connectivity between all node pairs (from the vmPFC to the amygdala and PAG, and from the amygdala to the PAG). Interestingly, the PTSD + DS group displayed the strongest intrinsic inhibitory connections within the vmPFC. Conclusions: These results suggest the contrasting symptom profiles of PTSD and its dissociative subtype (hyper- vs. hypo-emotionality, respectively) may be driven by complementary changes in directed connectivity corresponding to bottom–up defensive fear processing versus enhanced top–down regulation

Multiple Splenic Hamartomas in a Trauma Patient: Report and Literature Review of a Rare Entity

Abstract Introduction/Objective The most common non-hematopoietic primary lesions of the spleen are benign and vascular in nature. Most are encountered incidentally at autopsy, trauma, or by imaging. The histologic differential diagnosis is challenging and often requires the use of immunohistochemical stains to distinguish from other aggressive lesions. We present a case of multiple splenic hamartomas discovered incidentally in a routine surgical specimen. Methods A 46-year-old male trauma patient with no known medical history underwent splenectomy after sustaining a grade 3 splenic laceration. Results The specimen weighed 198 grams and featured hemorrhagic capsular disruption. Within the intact parenchyma were multiple non-encapsulated, discrete pale foci ranging in size from 1–9 mm. Microscopically, these corresponded to multiple well-demarcated nodules with tortuous slit-like and dilated vascular channels lined by plump endothelial cells with no significant atypia or mitotic activity, and CD8+/CD31+/CD68+ (focal)/CD21-/CD34- phenotype by immunohistochemical staining. The intervening stroma was disorganized, with abundant foamy histiocytes and scattered lymphocytes with no defined white pulp-like structures. Histopathologic and immunohistochemical findings supported a diagnosis of splenic hamartomas. Conclusion Exclusive to the spleen, splenic hamartomas are composed of mixed normal red and white pulp elements in disorganized configuration. They have no known demographic predilection and are exceedingly rare, with one institutional study reporting an incidence of 0.024–0.13% at autopsies. Congenital malformations of red pulp, neoplasms of red pulp, and post-traumatic reactive origin have been discussed as possible etiologies. Although rarely presenting with splenomegaly and hypersplenism, most cases are asymptomatic. Differentiation from other splenic vascular lesions is often challenging, and CD8 positivity in endothelial cells is usually a defining characteristic. Familiarity with the features of this rare and benign entity is important to distinguish it from malignant primary and metastatic tumors. </jats:sec

Concerns Over Divergent Approaches in the Diagnostics of Posttraumatic Stress Disorder

Stress-related psychiatric disorders across the life spa